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Traditional herbal remedies used in the management of sexual

impotence and erectile dysfunction in western Uganda


Maud Kamatenesi-Mugisha & Hannington Oryem-Origa
Department of Botany, Makerere University, P. O. Box 7062, Kampala, Uganda.
ABSTRACT
Background: The utilisation of ethnobotanical indigenous knowledge is vital in male sexual reproductive health care delivery in
western Uganda. Reproductive health care is the second most prevalent health care problem in Africa. However, this concept of
reproductive health care has been focusing mainly on women disregarding men. Thus, some diseases such as sexual impotence and
erectile dysfunction that deserve mention are regarded as petty though important in economic productivity, family stability and
sexually transmitted diseases control including HIV/AIDS.
Objective: This study was carried out mainly to document medicinal plants used in the treatment of sexual impotence and erectile
dysfunction disorders in western Uganda.
Methods: The medical ethnobotanical indigenous knowledge were collected by visiting traditional healers and documenting the
medicinal plants used and other socio-cultural aspects allied with sexual impotence and erectile dysfunction. The methods used to
collect the relevant information regarding the medicinal plants used included informal and formal discussions, field visits and
focused semi-structured interviews.
Results: Thirty-three medicinal plants used in the management of sexual impotence and erectile dysfunction were documented
and Citropsis articulata and Cola acuminata were among the highly utilized medicinal plants.
Conclusion: From the researchers point of view, the usage of herbal remedies in managing male sexual disorders is useful
because of long cultural history of utilisation and the current renewed interest in natural products to sustain health globally. As a
way recognising the values and roles of traditional medical knowledge in health care provision, further research into the efficacy and
safety of herbal remedies in male sexual disorders is precious in Uganda and beyond. More so, the establishment of rapport
between relevant government department in Ministry of Health, modern health workers through collaborative and networking
ventures with traditional healers under close supervision and monitoring of herbal treatments is noble.
Key Words: Medicinal Plants, Erectile Dysfunction, Sexual Impotence, Ethnobotanical Indigenous Knowledge, Western Uganda
African Health Sciences 2005; 5(1): 40- 49

INTRODUCTION
About 70 - 80% of the Ugandan population still
rely on traditional healers for day-to-day health care.
In some rural areas the percentage is around ninety
compared to 80% reported world-wide 10,13,14.
WHO32 had earlier estimates that the usage of
traditional medicine in developing countries is 80
%. This is an indication that herbal medicine is
important in primary health care provision in
Uganda. There are several reproductive ailments that
local communities have been handling and treating
for ages such as sexual impotence and erectile
dysfunction (ED). The concept of reproductive
health care has been focusing mainly on women
disregarding men and yet men are part.

Corresponding address:
Department of Botany, Makerere University
P. O. Box 7062, Kampala, Uganda.
Tel: 256-77-438905/256-41-540765
E-mail:mkamatenesi@botany.mak.ac.ug
mkmugisha@yahoo.com
African Health Sciences Vol 5 No 1 March 2005

Erectile dysfunction, sometimes, which also may imply to


refer to impotence, is the repeated inability to get or
keep an erection firm enough for sexual intercourse23,34.
The word impotence may also be used to describe other
problems that interfere with sexual intercourse and
reproduction, such as lack of sexual desire and problems
with ejaculation or orgasm23. Roper29 defines erectile
dysfunction as the total inability to achieve erection, an
inconsistent ability to do so, or a tendency to sustain only
brief erections (premature ejaculation). Pamplona-Roger27
defines impotence as the inability to finish sexual
intercourse due to lack of penile erection. These variations
make defining ED and estimating its incidence difficult.
For purposes of this publication, since ethnobotanical
indigenous knowledge (IK) cannot clearly distinguish
between these two terms, then erectile dysfunction and
sexual impotence are both used. The local people who
are providers of this information are not in position to
classify these two conditions.
The estimated range of men worldwide suffering
from ED is from 15 million to 30 million23. According to
the National Ambulatory Medical Care Survey (NAMCS),
for every 1,000 men in the United States, 7.7 physician
office visits were made for ED in 1985. By 1999, that rate
40

had nearly tripled to 22.3. This is in USA,


where statistics are clearly compiled, the level of
awareness and education is high as compared to
sub Saharan countries like Uganda. This is a clear
indication that there are many silent men, particularly
couples affected by ED.
Reproductive Health care is the second
most prevalent health care problem on African
continent4. Reproductive health care did not appear
on the health agenda until recent after the Cairo
conference on population and the Peking conference
on women that it indeed became a live issue4. In
some instances RH certainly includes the RH needs
of the youth or adolescents.
According to Ugandas health policy
priorities8,25, mens reproductive health is not given
any mention. The national health policy focuses on
services like family planning, diseases control like
STI/HIV/AIDS, malaria, perinatal and maternal
conditions, tuberculosis, diarrhoeal diseases and
acute lower respiratory tract infections that are given
priority8,25. The sexual and reproductive health rights
in Uganda focus on maternal and child mortality,
family planning and the like exclusive of mens sexual
needs and rights8.
The causes of ED are varies from one
individual to another. For whatever cause, since an
erection requires a precise sequence of events, ED
can occur when any of the events is disrupted. This
sequence includes nerve impulses in the brain, spinal
column, and area around the penis, and response in
muscles, fibrous tissues, veins, and arteries in and
near the corpora cavernosa23. Thus, ED causes
reported include, damage to nerves, arteries,
smooth muscles, and fibrous tissues. These are often
as a result of diseases, such as diabetes, kidney
disease, chronic alcoholism, multiple sclerosis,
atherosclerosis, vascular disease, and neurologic
diseases that account for about 70 percent of ED
cases23. NIH23 reported that between 35 and 50
percent of men with diabetes experience ED. NIH23
further reported that the usage of many common
medicines such as blood pressure drugs,
antihistamines, antidepressants, tranquilizers, appetite
suppressants, and cimetidine (an ulcer drug) can
produce ED as a side effect. Nevertheless,
psychological factors such as stress, anxiety, guilt,
depression, low self-esteem, and fear of sexual
failure cause 10 to 20 percent of ED cases. In
addition, men with a physical cause for ED
frequently experience the same sort of psychological
reactions (stress, anxiety, guilt, depression)23. Other
African Health Sciences Vol 5 No 1 March 2005

possible causes are smoking, which affects blood flow in


veins and arteries, and hormonal abnormalities, such as
not enough testosterone23.
In modern medication of erectile dysfunction, the
oral prescription medication of popular Viagra (Sildenafil)
is effective, but in some men it is not compatible and
Sildenafil works in less than 70% of men with various
etiologies and has certain side effects23. The availability of
Viagra has brought millions of couples to ED treatment.
Oral testosterone can reduce ED in some men with low
levels of natural testosterone, but it is often ineffective
and may cause liver damage 34. Other drugs such as
Yohimbine, papaverine hydrochloride [used under careful
medical supervision]5, phentolamine, and alprostadil
(marketed as Caverject) widen blood vessels. However,
this available modern medication for the ED in men is
very expensive for most of the rural people in Ugandan
and other developing countries. Yet, in traditional medicine,
there are several medicinal plants that have been relied on
for use in the treatment of ED. This ethnobotanical
indigenous knowledge has not been earlier documented
and scientifically validated for efficacy and safety, future
drug discovery and development.
Therefore, this particular study was carried out
purposely to document medicinal plants used by traditional
medical practitioners to treat ED and sexual impotence
and other male erectile related conditions in western
Uganda. This manuscript only covers the ethnobotanical
documentation of medicinal plants used in the management
of erectile dysfunction excluding the socio-cultural aspects.
The socio-cultural aspects in details will be presented in
the next manuscript covering the broad range of
reproductive health ailments management using the
indigenous knowledge in western Uganda.
STUDY AREA AND METHODS
This study was carried out in areas in and around Queen
Elizabeth Biosphere Reserve (QEBR) and some other sub
counties such as Katerera, Kichwamba and Kitagata in
Bushenyi and Munkunyu, Kayonza and Kitsinga in Kasese
districts in Western Uganda. The sampling sites were
located in the parishes around the biosphere reserve, and
in the selected fishing villages within the biosphere reserve.
These included, Katwe, Mweya, Katunguru, Hamukungu,
Kahendero and Kayanja Fishing Villages and many other
villages.
The study was conducted between April 2000
and March 2003 in western Uganda. To collect this data
indirect asking of questions and investigations that do not
refer or offend anyone were used since nobody especially
men can say openly that they have this problem. These
methods are explained in the textbook of ethnobotany
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and others have been used in the field for this kind
of studies in Uganda and elsewhere in the
world10,12,13,14,21. These methods included visiting the
traditional healers to document the indigenous
knowledge (IK), regarding medicinal plants used,
gender and socio-cultural aspects and where the
plants are harvested. Infor mal and formal
conversations, discussions and interviews, market
surveys and field visits were conducted.
The informal conversations were held with
the specialist resource users and other knowledgeable
people on particular ailments. The meeting places
were the gardens, women group meetings, at their
homes, and any other places convenient to them.
Through conversations, the sources of knowledge
of the healers on medicinal plants, the medicinal
plants used and changes in the availability of
medicinal plants were established. Those who were
more knowledgeable were later followed and
interviewed further especially the TBAs, and some
knowledgeable men healers. Focused discussions
were held with them later for formal recording. In
some instances, young mothers were visited too. This
was done to verify the information gathered and
the spread of the indigenous knowledge (IK) in
reproductive health care among the different
reproductive groups particularly on ED
management.
The semi-str uctured interviews and
discussions were held with the specialist resource
users and other knowledgeable people on particular
ailments by use of interview schedules for each
respondent. Interviewed people were mainly the
herbalists (both men and women) and TBAs. In this
selection to some extent, ethnic groups were
recorded where possible because different people
use the same plants differently. The time and place
of interviews were arranged according to the
schedules of the respondent. Depending on where
the interviews and discussions were held, recording
was done immediately or afterwards or
appointments were made for more details in a more
convenient place arranged with the respondent. Key
informants were identified and later interviewed
separately and even followed for further details.
Some of the key questions asked included, name
of the respondents, the village or parish or subcounty he or she was coming from, diseases treated,
plant local names used, parts harvested, methods
of preparation and administration. In addition,
ingredients and incantations with which the plants
are used for preparation and where the herbal
African Health Sciences Vol 5 No 1 March 2005

medicines were harvested were documented.


The field visits and excursions were arranged with
the healers for places far from their homesteads or took
place concurrently with the interviews and discussions.
When going to the forests, game reserves or other areas
where herbalists collect plant specimens, prior
arrangements were made with the community leaders and
park staff. This was done with individuals or groups
depending on where the herbs are collected. In the shared
areas such as the fishing villages, or the multiple use areas,
group and individual excursions were conducted. Some
of the medicinal plants that are harvested from distant
places such as the Democratic Republic of Congo, other
districts and unsafe areas within the reserve were not
collected but their local names were recorded. The data
collected were to supplement the information on plant
names, plant parts used, collection of the herbarium
voucher specimens and conservation status of these
medicinal plants. The medicinal plants collected were given
the voucher numbers and then later identified in Botany
Department herbarium of Makerere University.
The key respondents were mainly old men, male
traditional healers, traditional birth attendants and young
women and all in total about 160 traditional healers were
interviewed. To document male related ailments men are
particularly more knowledgeable and most men share their
problems with men. In addition, the old men and healers
are the ones in charge of administering these herbal
remedies. Young women through the informal discussions,
interviews and market surveys are particularly more
dynamic in the use of herbs for themselves, husbands and
children besides being the most active reproductive age
group. The medical ethnobotanical data collected has been
analysed, medicinal plants from the study areas have been
listed and methods of administering the herbal drugs were
also documented. In checking for the proper updated
naming, spellings and authors of the medicinal plants,
besides using voucher specimens in Makerere University
Herbarium, several reference books were used1,3,9,15,16,20,22,27.
RESULTS
Thirty-three medicinal plants both cultivated (Table 1) and
wild harvested (Table 2) were documented and identified
in the area of study. In the description below these results
of these two table are combined as presented below. All
the identified medicinal plants in both tables belong to 25
families and 30 genera. The family Rubiaceae (4) is the
most represented followed by Alliaceae, Euphorbiaceae,
Mimosaceae, Papilionaceae and Caesalpinaceae families
which have two species each and the rest with one species.
The composition is that 42.4% are shrubs, 39.4% herbs
and herb climbers and 18.2% trees. Leaves (57.6%) are
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the commonest plant parts followed by roots (42.1%), barks (27.3%) and the rest of the plant parts harvested
have less than 10% of the parts harvested. From Allium cepa, Allium sativum, Rhus vulgaris, Warburgia ugandensis, Cleome
gynandra and Tarenna graveolens, three different plant parts, are harvested for use in sexual impotence and erectile
dysfunction. In the case of Impetiens species and Urtica massaica, the whole plants are harvested while the rest of the
species one or two different plant parts are used. The conservation status of these documented plants is that
27.3% are cultivated while 72.7% are collected from wild places. The common methods of plant medicine
preparation included boiling, chewing, pounding, cooking, roasting and smoking. The commonest method of
herbal administration was by oral means as food, herbal teas or by mixing in several drinks including locally made
beer.
Table 1. Cultivated Medicinal Plants used in treatment of Sexual Impotence and Erectile Dysfunction in Western
Uganda
Family

Scientific Name

Local Name

Alliaceae

Allium cepa L.

Alliaceae

Allium sativum L.

Cannabaceae

Cannabis sativa L.

Capparaceae

Cleome gynandra L.

Malvaceae
Papilionaceae

Sida tenuicarpa
Vollesen
Arachis hypogaea L.

Katunguru
H
(NY, KI, RU)
Onion (Engl.)
Tungurusumu H
(KO)
Garlic (ENG)
Njayi (GA)
S
Njaga (NY)
Marijuana (ENG)
Mbangi (SW)
Esobyo/
H
Amarera (KO)
Eshogi (NY)
Keyeyo (RU)
H

Rubiaceae

Coffea arabica L.

Solanaceae

Capsicum frutescens L.

Zingiberaceae

Zingiber officinale
Roscoe

Binyebwa (NY,
RU)
Ground nuts
(ENG)
Mwani (NY)
Arabica Coffee
(ENG)
Kamurari (GA)
Eshenda (NY)
Red pepper
(ENG)
Ntangahuzi
(NY),
Ntangawizi
(SW),
Ginger (ENG)

Habit

Parts Used Preparation Administration


ST-BU, L, RT chewing,
cooking

oral in water
and in food

ST-BU, L, RT chewing,
cooking

oral in water
and in food

chewing,
smoking

oral, inhaling
fumes

L, R, FL

chewing,
cooking

oral or as food

pounding,
boiling
roasting

oral

SE

oral as food

SE

roasting,
chewing

oral as a beverage

FR

pounding,
boiling,
chewing

oral in food

RH

pounding,
boiling

oral in tea,
porridge,
milk as a beverage

Key: SW (Swahili); ENG (English); KO (Rukonjo); RU (Runyaruguru); NY (Runyankore); KI (Rukiga); GA (Luganda);


S (shrubs); H (herbs); L (leaves); R (roots); RT (root tuber); RH (rhizome); FR (fruits); SE (seeds); ST-BU (stem-bulb).

African Health Sciences Vol 5 No 1 March 2005

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Table 2. Wild-harvested Medicinal Plants used in treatment of Sexual Impotence and Erectile Dysfunction in Western
Uganda
Family

Scientific Name

Local Name

Habit

Parts Used

Preparation Administration

Anacardiaceae

Rhus vulgaris Meikle

B, R, L

Asclepiadiaceae

Mondia whiteii Skeels

Mukanja (NY)
Mukanza (RU)
Mulondo (GA)

Asteraceae

Vernonia cinerea (L.) Less. Kayayana (GA)

oral and eaten


as raw fruits
oral in water, in
tea and in
food
oral

Balsaminaceae

Impetiens sp.

Caesalpinaceae

Cassia didymobotrya
Fresen.

chewing,
boiling
chewing,
boiling,
pounding
chewing,
boiling
chewing,
boiling
chewing,
boiling

Caesalpinaceae

Cassia occidentalis L.

oral

Canellaceae

Warburgia ugandensis
Sprague
Catha edulis

chewing,
boiling
pounding,
boiling
chewing

Celastraceae

Entungwabaishaija
(NY)
Mugabagaba (NY)
Mukyora (RU)
Mucora (KO)
Mwitanzoka (NY,
KO)
Mwiha (RU)

H-CL

L, R

WP

L, R

L, R

B, L, R

Mairungi (NY, RU), S


Miira (SW)

L, ST

Omukarara (RU)
Omukalali (KO)
Engyenyi (NY)

L, R

Euphorbiaceae

Flueggea virosa (Willd.)


Voigt
Tragia brevipes Pax.

H-CL

Mimosaceae

Acacia sieberiana Scheele

Munyinya (NY, RU) T

Euphorbiaceae

Mimosaceae

Dichrostachys cinerea
(L.) Wight & Arn.
Macrotyloma axillare
(E.Mey.) Verdc.
Myrica salicifolia
Hochst. ex A.Rich.

Muremanjojo (RU)

Akaihabukuru /
Kihabukuru (RU)
Mujeje (NY)

H-CL

L, RT

R, B

Palmae

Phoenix reclinata Jacq.

L, R

Phytolaccaceae

Phytolacca dodecandra
L Herit

Akakindo (NY),
Mukindo (NY)
Muhoko (NY)
Ruhuko (KO)

L, R

Myricaceae
Myricaceae

Polygonaceae

Coffea spp.

Polygonaceae

Hallea
rubrostipulata (K.Schum.)
J.F. Leroy
Rumex abyssinicus
Mufumbagyesi
S
Jacq.
(NY)
Mufumbijesha (RU)
Kasekekambaju
(GA, KO)
Tarenna graveolens
Munyamazi (KO,
S
Munywamaizi (NY)
RU)

Polygonaceae

Polygonaceae
(S.Moore ) Bremek.

African Health Sciences Vol 5 No 1 March 2005

Mwani (NY)
S
Wild Coffee (ENG)
Muziiko (NY)
T

SE
B, R

pounding,
boiling
pounding,
boiling
pounding,
boiling
pounding,
boiling
pounding,
boiling
pounding,
boiling
pounding,
boiling
pounding,
smearing
roasting,
chewing
pounding,
boiling

oral
oral

oral in tea
or porridge
oral by chewing
fresh leaves and
young stem.
oral
oral
oral
oral
oral
oral
oral
smear on ripe
banana
and roast
oral as a
beverage
oral

L, ST

chewing

oral

B, L, R

pounding,

oral
boiling

44

Family

Scientific Name

Local Name

Rutaceae

Citropsis articulata
Swingle &
Kellerman
Cola acuminata
Schott & Endl.
Grewia similis
K. Schum.
Urtica massaica Mildbr.

Sterculiaceae

Tiliaceae
Urticaceae

Habit

Parts Used

Preparation Administration

Muboro (NY, RU) T


Katimboro (KO, TO)

B,R

Ngongolia (SW),
T
Engongoli (KO, RU)
Cola nut (ENG)

FR

pounding,
boiling,
chewing
Roasting,
pounding,
chewing

Mukarara (RU)

L, B

Engyenyi (NY)

H-CL

WP

pounding,
boiling
pounding,
boiling

oral as
beverage
in tea
oral in tea,
porridge,
milk as a
beverage
oral
oral

Key: SW (Swahili); ENG (English); KO (Rukonjo); RU (Runyaruguru); NY (Runyankore); GA (Luganda); TO


(Lutooro); T (trees); S (shrubs); H (herbs); H-CL (herb-climber); ST (stem); B (bark); L (leaves); R (roots); RT
(root-tuber); FR (fruit); SE (seeds); WP (whole plant).
DISCUSSION
A list of 33 medicinal plants both cultivated and
wild-harvested generated show that herbal remedies
are greatly utilized by men for managing sexual
impotence and erectile dysfunction in western
Uganda. Erectile dysfunction and sexual impotence
are old problem and traditionally the indigenous
knowledge had ways of treating or managing these
conditions associated with male reproductive
system. These plants in the tables we are discussing
have been in use for centuries in treating or managing
conditions in male reproductive organs.
The medicinal plants used such as Citropsis
articulata, Cannabis sativa, Cleome gynandra and Cola
acuminata are frequently utilized. Some of these plants
(Citropsis articulata, Cola acuminate) are already under
sale for treating these conditions. Their propagation
is on-going in western Uganda in places like
Rukararwe Partnership Workshop for Rural
Development Centre in Bushenyi District36 and
researchers personal experience at Rukararwe.
Rukararwe is a non-governmental organisation that
is processing herbs, running a famous herbal clinic
and with a medicinal plants arboretum and
medicinal plants agro-forestry.
A plant like Cleome gynandra is a popular
vegetable used all over Uganda and is on sale in
most markets. Other medicinal plants that are food
stuff include Allium cepa (onions), Allium sativum
(garlic), Rhus vulgaris, Capsicum frutescens(red pepper)
and Zingiber officinale (Ginger) are also on sale in most
markets of Uganda and internationally. In addition,
the roots of Mondia whiteii are used as an aphrodisiac
for males and for improving female sexuality
(womens Viagra) in most areas of Uganda 11
African Health Sciences Vol 5 No 1 March 2005

particularly in urban centres and the Kampala City. To


date, Mondia whiteii has been an old traded medicinal plant
in most in Kampala. Recently the patented Mulondo Wine
a drink flavoured by the roots of Mondia whiteii has hit the
national and international markets35. The Mulondo Wine
is also believed to be an aphrodisiac for both men and
women.
The herbal medicines used in the management of
sexual impotence and erectile dysfunction are mainly
prepared by pounding, chewing and boiling and are mainly
orally administered. The traditional healers treat sexual
impotence and ED by prescribing some of these herbs in
tea or using local beers, fermented milk and porridge.
Some herbs are herbs are roasted or smoked such as
coffee before administration. The dispensing of herbal
medicines used in sexual impotence and ED using local
beers, fermented milk and porridge possibly the alcoholic
content improves on the kind of active chemicals extracted
than water alone12 .
Some studies carried in and outside Uganda show
that some of these plants listed in the management of
sexual impotence and ED may be potent. Some of these
medicinal plants are regarded as traditionally aphrodisiacs,
implying that they have ability to increase sexual desires.
For instance, Cola acuminata fruits are widely used herbal
remedies in ED and are harvested from the forests of
Democratic Republic of Congo. The Cola acuminata fruits
contain about 2% catechine-coffeine (Colanine)7. The
roasted seeds in Europe are used as strong stimulant, in
addition to the treatment of migraine, neuralgia, diarrhoea
and stimulant or cardiotonic, loss of appetite, antidepressant and melancholy (severe form of depression)7.
Coffee is drunk for certain migraine, nausea, resuscitation
and diuretic7. Coffee is a famous stimulant used world
45

over as a beverage. However, the wild coffee


species are more popular in treating ED and are
believed to contain more alkaloids (caffeine). Coffee
is further reported to be a nervous system stimulant (Pampalona-Roger, 2000). Cannabis sativa (Marijuana) is smoked by mentally sick and impoverished
men7. C. sativa is like morphine, it is an opioid
analgesics. Allium sativum (garlic) is used in treatment
of diabetes, high blood pressure, prevention of
arteriosclerosis (hardening of the arteries and is one
of the causes of ED)7. Garlic reduces blood sugar
levels and blood cholesterol levels which are the
direct causes of ED if not checked. The Zingiber
officinalis (ginger) volatile oils from the rhizome are
used for stimulating the nerves and making then
sensitive7. Capsicum frutescens in many African cultures is a known powerful stimulant and carminative24. Capsicum frutescens (chilli) contains enzyme
capsaicine that helps in blood clotting (fibrinolytic)
and people who consume C. frutescens seldom suffer
from heart attack. In addition, the pharmacological
tests showed that the capsaicin chemical compound
from Capsicum frutescens acted like powerful stimulant of the receptors participating in circulatory and
respiratory reflexes24.
Phytolacca dodecandra leaves and roots are
pounded and smeared on ripe banana and then the
ripe banana roasted before being eaten for treating
erectile dysfunction. However, care has to be taken
Phytolacca dodecandra is poisonous. Cola acuminata fruits
are mixed with other plants in Benin to treat primary
and secondary sterility24. Cola acuminata is also said
to be diuretic and laxative when administered
orally 24 . Some Acacia species are regarded as
aphrodisiacs in Niger2. Cassia species have high
repute as drugs and poisons. For instance, Cassia
sieberiana is used urinary problems, impotence and
kidney diseases in Mali24. In Burkina Faso, Cassia
occidentalis is used as a stimulant24. Flueggea virosa is
famous medicine in African cultures. Flueggea virosa
used in sterility, aphrodisiacs, stimulant, rheumatism,
arthritis, spermatorrhoea, kidney and liver problems
among many other diseases treated17,24.
In Uganda gender specific malfunctions or
complications or diseases and conditions in reproductive health care are not given the due regard
and the suffering persons tend to shy away. Sexual
impotence and ED in men is considered a secret
affair and the suffering persons keep quite or seek
medical help in privacy. The psychologically affected
men will try other women to test the viability of
their manhood. The same is true, women with
African Health Sciences Vol 5 No 1 March 2005

spouses with such erectile problems may be tempted to


go outside their marriage vows to satisfy their sexual needs.
, This can also lead to HIV/AIDS exposure and result in
broken homes and marriages12 . The consequential
outcomes of promiscuity, low self-esteem, polygamy,
sexually transmitted diseases including HIV/AIDS are
more detrimental to the individuals and society.
Only the few elite (educated) and with money
seek modern medical care privately and secretly. The description of impotent men in western Uganda among the
Banyankore ethnic grouping is literally translated as the
persons having no legs (Kifabigyere, Runyankore Dialect)
to imply that the penis is dead (cannot bear children). There
are other various terms used to describe such men with
sexual impotence and ED like the one trampled by a goat,
[Akaribatwa embuzi (empene), Kinyankore dialect]. In
other places they called, such men who were unable
reproduce as Ekifera in Kinyankore meaning worthless).
The men who were unable to have children were not
supposed to be given the positions of responsibility or
leadership because they were regarded as abnormal. Socially
these men were excluded from society, even on drinking
joints for the local brew or beer, they are not expected to
talk and if they talked, they are hushed. Even women and
children always taunted the suffering individuals. Socioeconomically, sexual impotence and ED is demeaning and
tortures the sufferers by reducing their self-esteem and
worthiness in the society. Culturally, in olden days, the impotent men married wives and entrust their wives to very
close friends and or relatives to bear them children. In
central Uganda, the men with erectile problems are equalled
to car engines that cannot start on their own [ non-starters] or cars whose batteries have no or low charge (Takuba
self , Luganda dialect).
Although there are few men who are born
absolutely impotent, the number of men with erectile
problems are many especially those tending to 50 years
and above. Pfizer28 reported that about 40% of men
above years, 50% of men above 50 years, 60% of men
above 60 years and in any population are affected by ED.
ED has profound effect on psychological well being, it
can be devastating, it can lead to low self-esteem,
depression, negative effect on relationships and reduced
life satisfaction28. Among several other causes, aging is one
of the factors leading to ED. There are some other social
causes of ED such as high unemployment rates, and
diseases like diabetes, hypertension, HIV/AIDS, high
cholesterol levels, stress, smoking and obesity28. ED is
slowly creating adverse problems in homes in Uganda
and particularly, among the mid-aged and old men. The
men with sexual impotence and erectile dysfunction deserve
proper diagnosis of the conditions and treatment. Thus,
the plant remedies described may be healthy if administered
46

Erectile dysfunction is a common problem


in men of all ages than publicly perceived. Since, I
started the research in reproductive health care; the
commonest question asked by men is related with
medicinal plants that empower male sexuality. So
far, several males have been consulting on the
treatment of ED using herbal remedies, either by
themselves or through friends12.
The proved herbal remedies with
therapeutic values such as Prunus africana used in the
treatment of hypertrophy in male genitalia is indicative that some herbals may be potent though not
yet studied comprehensively5,13. However, most of
the herbal remedies used in male ailments are not
well documented and researched. The dangers of
loosing valuable indigenous knowledge (IK) on
sexual impotence and ED are likely to occur because
westernization in the present generation. This
indigenous knowledge in medicine ought to be
documented for future use and sustainable utilisation19. According to the convention on biological
diversity (CBD)6, specific reference is made to the
need to protect the worlds indigenous cultures and
traditions (Art. 8 of CBD). This article points out
that national legislation need to respect, preserve
and maintain knowledge, innovations and practices
of indigenous and local communities encompassing
traditional life styles relevant for the conservation
and sustainable use of biodiversity. UNEP argues
nations to have an urgent action to safeguard
indigenous cultures and their knowledge.
From the conservation point of view,
medicinal plants usage will continue to grow in
popularity as people seek ways to support health
naturally and gently31. So far, over 72% of these
medicinal plants used in ED conditions were
harvested from the wild. Yet, there is increasing trend
in usage of traditional medicine in developed
countries30. The dramatic increase in herbal remedies
usage will continue to rise since WHO has taken on
monitoring of all unconventional medicine
according to the traditional medicine strategic plan
of 2002 to 200533. Most medicinal plants have
proved successful sources or have acted as leads
of effective ingredients that todays drug companies
often look first to traditional places such as the rain
forests, forest animals and traditional healers for
clues to guide their drug development efforts.
Furthermore, the harvesting of medicinal plants
from the wild places such as the forest reserves,
national parks in QEBR is a point of concern
whereby no viable mechanisms have been put in
African Health Sciences Vol 5 No 1 March 2005

place to propagate them. The plant parts harvested


especially those of wild medicines such as roots and stem,
pose threat to the future survival of natural reservoirs if
domestication strategies are not adopted in the near future.
This calls for serious conservation strategies of plant
targets in drug development borrowing from the
indigenous knowledge of the local people. For instance,
medicinal plants documented in this study like Warburgia
ugandensis and Cirtopsis articulata used in erectile dysfunction
and sexual impotence and ED need to be conserved based
on their demand and medicinal value to the people. In the
event of increased biotechnology and the use of modified
living organisms in agriculture, health and environment,
most people will go for natural products18,26. Furthermore,
research in natural products is on the increase in both
developed and developing nations to show that there is
renewed interest in medicines of natural origin.
The medicinal plants used in male-related conditions will be very significant in the present and future
generations. From the researchers point of view, the usage
of herbal remedies in managing sexual impotence and
erectile dysfunction is useful because of long history of
utilisation of some herbs that are perceived as effective.
Thus, the establishment of rapport between modern health
workers through collaborative ventures with traditional
healers, relevant NGOs like Rukararwe in Bushenyi by
having close supervision and monitoring of herbal
treatments in such conditions is noble. Ministry of Health
through its research wing in traditional medicine the Natural
Chemotherapeutics Research Laboratory in Wandegeya
has role to play in advocacy of traditional medicine. In
addition, Public-Private Partnership in Health Care Delivery
Desk Office in Ministry of Health and distinguished
researchers in herbal medicine need to network, collaborate
and have policy in place for herbal medicine as an alternative form of health care in Uganda. The traditional herbal
medicines, relevant to the needs of ailing Ugandans can
be tried out after being licensed by the National Drug
Authority. In our view, sexual impotence and erectile
dysfunction are real silent conditions affecting Ugandan
men. Additionally, further investigations into the safety and
efficacy of these traditional herbal remedies used in the
treatment of erectile dysfunction and other male-related
conditions are recommended in Uganda.
ACKNOWLEDGEMENTS
Most sincere gratitude to the sponsors, Third World Organisation for Women in Sciences (TWOWS), NUFU
Medicinal plants Project through Botany Department,
Faculty of Science, Makerere University, UNESCO-MAB
Young Scientist Research Award, 2000, Gender
47

studies, Makerere University and WHO-Uganda.


The Staff of Queen Elizabeth National Park, Field
assistants, local leaders, the resource users and all
respondents, particularly the TBAs and traditional
healers in Bushenyi, Mbarara and Kasese Districts
who provided the information.
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